Podiatry Blog

Shockwaves are movements of extremely high pressure. In everyday life shockwaves can be caused by explosions, earthquakes or a plane breaking the sound barrier. In medicine, this application has been developed into Extracorporeal Shockwave Therapy (ESWT).

HOW DOES SHOCKWAVE THERAPY WORK?

Shockwave therapy uses an acoustic wave which carries high energy to painful spots within musculoskeletal tissues. The energy promotes regeneration and reparative processes within the bones, as well as tendons, muscles and other soft tissues. This leads to overall medical effects of accelerated cell growth and tissue repair, analgesia and mobility restoration.

WHAT ARE THE SPECIFIC PHYSIOLOGICAL EFFECTS OF SHOCKWAVE THERAPY?

New blood vessel formation

Reversal of chronic inflammation

Stimulation of collagen production

Dissolution of calcified fibroblasts

Dispersion of pain mediator "Substance P"

Release of trigger points

WHAT INJURIES CAN SHOCKWAVE THERAPY TREAT?

Shockwave therapy is a treatment option for almost all sub-acute, sub-chronic or chronic musculoskeletal injuries, including:

Jumper's knee

Patellofemoral pain syndrome

Heel spur

Insertional pain

Chronic tendinopathy

Medial tibial stress syndrome

Calcifications

Plantar fasciitis

Non-union fractures

Osteoarthritis

IS THERE ANY RESEARCH EVIDENCE SUPPORTING THE USE OF SHOCKWAVE THERAPY?

Medial Tibial Stress Syndrome (shin splints) - 85% of patients receiving shockwave therapy returned to active sports faster than the control group receiving no shockwave;

Chronic Plantar Fasciitis - decrease in pain of more than 60% in patients with chronic plantar fasciitis after 3 months;

Insertional and Non-Insertional Achilles Tendinopathy - 75% of patients had significant improvement in pain and range of motion;

Knee osteoarthritis - 95% of patients had a reduction in painful symptoms and improvement in function of the knee joint;

Children with Cerebral Palsy - improvement in muscle spasticity and motor function;

Most patients tolerate SWT extremely well and report only minor discomfort during treatment, which ceases as soon as treatment is finished. Treatments typically last 5-10 minutes.

HOW MANY TREATMENTS WILL I NEED AND HOW OFTEN?

This is totally dependent on the injury and the individual. The effect of SWT is cumulative so you will need more then 1 treatment. Typically, 3-5 treatments are recommended, with 3-10 days between treatments. Again, this is dependent on the tolerance of the patient and their tissue response.

ARE THERE ANY RESTRICTIONS FOLLOWING TREATMENT?

It is recommended that patients refrain from physical activity, especially one that would involve the treated region, for 48 hours following each treatment session.

If you are interested in this as a treatment option for you - give us a call and ask for an appointment with Nerida

It's that time of year again - time to get fitted for new school shoes!

It is always best if you can go somewhere and have your children fitted for their school shoes by a fitting professional such as The Athlete's Foot - but that isn't always possible. Here are some tips to make sure your children's footwear fits correctly:

* First consider what type of shoes does your child need - Joggers? Traditional leather shoes? Make sure the shoe is correct for the activity required. There are shoes out there for the active child who loves a run around at lunchtime that require a more traditional leather upper for certain days of the week. Your handball champion's shoes will last much longer if the shoe is correct for their activity levels.

*Always allow about a thumb width room for growth (make sure this is slightly less in younger children as you don't want them tripping).

* Work out what fastening mechanism works best for your child - laces or velcro. If they are a shoe size that is difficult to get velcro in consider swapping the laces out for no tie elastic laces. These can be a great help!

* Make sure the shoe is wide enough and deep enough around the toes and across the widest part of the forefoot. A shoe that is too shallow or narrow puts pressure on the toes and forefoot and could lead to calluses, corns and/or blisters.

* Make sure the shoe only bends at the forefoot and has a firm heel counter to allow the shoe to maintain a good structure.

* Finally, make sure your child is comfortable in the shoe and will happily wear them!

Enjoy the rest of the school holidays and good luck to all those starting school for the first time!

If you have any questions about your child's feet, please do not hesitate to contact us and come in and see one of our friendly podiatrists.

The warm summer days are upon us. As we break out the summer wardrobe and footwear, beware, there are several foot problems that we consistently see over the summer months that need some thought and planning so as not to ruin your Christmas holiday.

WHAT'S WRONG WITH THONGS?

While thongs (or flip flops) are an iconic part of Australian summer, they are also responsible for considerable foot pain and injury. Unfortunately, the thin rubber sole of a thong, or any light summer sandal, does not provide our feet with the necessary support required in the heel, arch or ball of the foot. This is because there is no stability, causing the foot to move inapproriately while walking. This can lead to blisters, cramping, cracked heels, or worse, internal structural damage. The strap on the top holding the foot in place is also not sufficient, leading to clawing of toes potentially leading to toe deformities, corns and callous. Therefore, thongs should not be worn for long periods or when you are planning in doing a lot of walking. However, thongs do protect the foot from hot sand at the beach or prevent the spread of athlete's foot at the pool, so used sparingly and for appropriate activities they can keep a spot in your summer wardrobe.

PREVENT FUNGAL INFECTIONS

If you love getting your feet out in summer and enjoy the feeling of being barefoot, beware as you may also be enjoying the feeling of fungus between your toes. Unfortunately, summer always sees a rise in fungal infections of both the skin and nails, as well as plantar warts. This is because fungus and the virus responsible for plantar warts are rife in communal pool and bathing areas, especially at the beach and gyms. The increased number of people barefoot in summer in these areas also increases the risk of developing a fungal infection. To help to avoid this it is important to wear suitable footwear as much as possible, such as thongs in communal areas at the beach or pool. Also, remember to clean and dry feet regularly and thoroughly, especially between the toes to avoid tinea. If your shoes do get wet allow them to dry completely before wearing them again as fungus thrive in damp, dark places.

FOOT INJURIES

Going barefoot in the summer is only natural and has some benefits for short periods of time but is not recommended for outside the home. Too often, injuries occur from punctures or cuts. Always wear covered footwear outside the home or at work. If engaging in water activities, such as canoeing or kayaking, try to wear water shoes or sandals to protect your feet along rocky shorelines or river beds. If an injury has occurred, contact your podiatrist or doctor immediately.

HEAL YOUR HEELS

During the summer our heels are prone to dryness and cracking due to excessive sweating, decreased moisture in the air, open-backed shoes and no shoes at all. This can be very irritating for people and may lead to breaks in the skin and infection. There are simple ways to avoid this, including wearing enclosed shoes to prevent skin dehydration, using a heel balm to rehydrate skin and using a pumice stone in the shower to keep superficial dry skin as thin as possible. As podiatrists we can also help with removal of excess skin during your consultation and help you keep on top of what can become a difficult problem to manage.

WEAR SUNSCREEN!

Don't forget to apply sunscreen to the tops of your feet and toes. This area is often forgotten, however, if your feet are exposed, they will get burned and are prone to skin cancer. Also remember to re-apply sunscreen as directed or as soon as you get out of the water.

Like your car, your running shoes need to be checked on a regular basis - and just like your car tyres, after a certain amount of kilometres they need to be replaced.

The 'spongy stuff' that shoes are made from in most cases is called EVA (ethyl vinyl acetate). EVA has only so many compressions before it starts to loose its structure and function. You can tell where this is occurring by looking at the wear patterns on the sole - as the tread starts to become thinner, this is an indication that this particular part of the shoe is under higher load. You may also start to see creases looking at the side of the sole where the EVA has compressed.

A shoe that has worn past its use by date can lead to injury as your foot does not have a flat plane to make contact with the ground. The use by date differs from person to person based on how many kilometres you run, what type of training you do, the running surface you are on, your run technique and biomechanics, your weight and even if you are male or female.

If you are serious about your running, keep a record of how far you run and check your shoes every couple of hundred kilometres. You can also increase the life of your shoe if you have two pairs of shoes on the go at the same time, alternating between the two pairs in your training. If you have an event coming up, you will then know which shoe you feel most comfortable in and can use for race day.

Next time you start to get running pain - have a look at your shoes. It may be a sign they are past their use by date and make an appointment with our podiatrists to ensure nothing else is contributing to the problem. They can also steer you in the right direction to select your new shoes!

With running season well and truly underway, lots of little niggles (or not so little) aches and pains may be showing up in your training before or after these big runs. One common, and quite often debilitating issue we see a lot of during running festival times is the dreaded shin splints.

WHAT IS SHIN SPLINTS?

Shin pain, shin splints and Medial Tibial Stress Syndrome are all common terms generally referring to pain felt along the anterior (front) medial (inside) part of the lower leg. While typically experienced by runners, it can affect athletes across various sports. Shin splints itself is a loose term and generally involves one (but can often have several or all) of three pathologies - bone stress, inflammation and/or increased compartment pressure in the leg.

SOME CAUSES OF SHIN SPLINTS

Overpronation: with excessively pronated feet (flat feet or rolling in feet) the mechanics of your feet aren't working to their potential and a pulling force is creating overstretch which results in muscle fatigue and inflammation

Rigid/cavus (high arch) foot type: with a high arched or rigid foot structure, the shock of the foot hitting the ground in running isn't absorbed as well as those who roll in a little more and this may result in that shock being sent up the shin increasing impact pressure causing bone stress

Tight muscles: tightness paritcularly in the calf muscles can limit the ankle dorsiflexing (lifting upwards) and increase the amount of pronation (rolling in) leading to more internal twist of the tibia causing strain/inflammation

Weak muscles: weakness in the tibialis anterior muscle (a muscle that helps to lift the foot up) loses some of its strength to slow down/decelerate foot pronation causing the foot to slap to the ground

Increased compartment pressure: overuse and inflammation of the muscles in each of the compartments in the leg cause the leg to become swollen and painful. This can easily escalate to a more serious medical emergency if not diagnosed and treated.

Footwear: worn out, tired or overused sports shoes (joggers) could contribute to some of the already mentioned problems. Did you know that there are certain types of sports shoes for certain foot types and specific sports? You could be in the wrong type of sport shoe...

Running surfaces: uneven or downhill surfaces put undue stress on the feet and lower legs so may increase problems with your running

WHAT CAN I DO TO TREAT SHIN SPLINTS?

The treatment for shin splints really does depend on what the cause of the shin pain is. Initially, rest is important. However, the Australian Institute of Sport argue that total rest can be worse for injury and suggest a restriction of activity - so maybe walking, cycling or swimming instead of running (keeping your fitness up but reducing the amount of shock and force that running may cause). Applying icepacks and using anti-inflammatory medications can help with the pain caused by inflammation. Some of our podiatrists here at Freeman Podiatry can offer treatments which include dry needling and mobilisation which may help in the treatment of your shin pain.

Our podiatrists can also assess your feet and sports shoes during a biomechanical assessment to help address some of the biomechanical causes (overpronation, foot type, footwear) that may be causing your shin pain and rule out more serious concerns such as a stress fracture causing the pain. Sometimes we may need to implement the use of foot orthotics to assist your foot function and alignment to reduce the stress of forces that are causing shin pain.

If you or somebody you know has been experiencing shin pain, consider podiatry as your first port of call and book in for a biomechanical assessment with one of our podiatry team today.

Falls are a major concern as we age - it is estimated that 1 in 3 people over the age of 65 experience a fall at least once a year.

There are numerous medical causes that can lead to falls such as medication, poor sensory input, neurological conditions and cognitive decline. However, lower limb problems remain a large contributor and can be minimised with regular visits to your podiatrist. The main contributing factors that we assess and treat are:

FOOT PAIN

In older people this is most commonly caused by arthritis, fat pad thinning, ingrown toenails, highly calloused regions or corns, and deformities of the foot. In such cases, a podiatrist can help you by providing specialist nail care, proper footwear advice or should it be required, referral to another health care practitioner.

NEUROLOGICAL OR VASCULAR PROBLEMS

Nerve damage, such as diabetic polyneuropathy, may cause falls due to the inability to feel the ground due to loss of sensation. Vascular disease can impact your ability to find properly fitted shoes due to symptoms such as swelling. Non-invasive testing can be performed by your podiatrist to determine your neurovascular status and a referral for further investigation given if required.

MUSCULAR WEAKNESS AND IMBALANCES

Muscular imbalances may have a profound impact on balance and walking speed which may often lead to loss of confidence. A podiatrist can guide you to improved muscular strength and stability after specific lower limb testing.

BIOMECHANICAL ABNORMALITIES

Often compensatory mechanisms are the cause of injury and musculoskeletal damage leading to poor lower limb function. Common structural issues such as heavy pronation or supination, flat foot or high arch respectively, can affect the way you walk which may in turn affect other joints and muscles higher in the lower limbs and back. Poor foot posture may be the reason for early fatigue in daily life and can be easily treated through exercise regimes and orthotic therapy when required.

Key footwear advice that may help to reduce your risk of falls:

It is best not to buy backless shoes such as slide on slippers. The heel counter should be high and firm enough to support the entire ankle.

Buy for FIT, not for size. A shoe should accommodate protruding bony areas by being wide and deep. Your longest toe should be approximately 1cm from the end of the shoe (and this may not always be your first toe!)

When trying on shoes, put on both and go for a walk to make sure your heels are not slipping out of the back of the shoe.

Fit shoes with your usual socks/stockings/orthotics - and please ensure you try them towards the END of the day as your feet will most likely have swollen a little after your daily activities.

Choose a quality sole! Pick one that is not too thick - as it makes the ground harder to feel, but also not too thin - as there won't be enough cushioning.

Make sure the sole isn't slippery, but also not too sticky as both can increase the risk of falls

Shoes should only flex where the toes flex!

If wanting to wear a heel choose low, broad square heels

So you don't have to worry about your shoes slipping off (and your feet having to overwork), buy shoes with a fastening mechanism eg. velcro, laces, buckle

Shoes should not be too heavy - excess weight will increase fatigue in the legs

Little to no stitching in the upper material can help to prevent pressure points

Shoes must be replaced, repaired and cleaned regularly (ask your Podiatrist for some tips)

Wearing shoes around the house is proven to minimise the risk of falls

If you or someone you know is at risk or prone to falling, make an appointment with one of our friendly podiatrists today!

Now that the netball season is up and running, it may be time to check that your feet and shoes are up and running too!

While netball is considered a non contact sport it is surprising how many injuries can occur when playing, with a large number of these occurring in the foot and ankle. The constant demands on the court with pivoting, jumping, quick stop and starts can lead to both acute and chronic lower limb injuries.

Injuries include:

ANKLE SPRAINS - which occur with overstretching of a ligament (which connects bone to bone) and can sometimes be severe enough that a fragment of bone tears away with the ligament. It is an acute injury, but some foot types are more prone to sprains then others. It is essential after these injuries proper rehabilitation occurs to regain strength in the area.

ACHILLES TENDINOPATHIES - This condition tends to be a progressive problem with pain and thickening of the tendon behind the ankle. Pain can be noticed when getting out of bed, running or climbing stairs. Tightness in the calf muscle, training errors or poor foot position are major factors in its development and if not treated early can become a chronic problem or lead to a tear.

BURSITIS - Inflammation of a bursa (fluid filled sac which helps minimise friction) can become painful, swollen and hot. Bursitis of the forefoot can be associated with foot shape and shoe cushioning along with the increased pressure from pivoting and being up on the toes when playing. It can also occur behind the heel with tight footwear or alongside achilles tendinopathies.

PLANTAR FASCIITIS - This develops with micro tears of the plantar fascia (the thick fibrous band connecting from heel to toes). Pain can be experienced at the heel or through the middle of the fascia with many reporting the pain worst with the first steps of the day or after resting. It can be associated with high impact forces and high or low arches.

SHIN SPLINTS - Pain with this condition occurs along the muscle at the front of the lower leg and can progressively become worse as the game goes on. It is mainly associated with overuse due to overtraining, but can be exacerbated by poor foot and leg biomechanics and incorrect footwear.

KNEE INJURIES - The repetitive jumping and landing in netball coupled with poor mechanics can lead to problems such as patellofemoral syndrome, patella tendinitis and anterior cruciate ligament sprain.

SKIN AND NAIL - Problems such as blisters, calluses and ingrown toenails can all occur and if not correctly managed may keep you unnecessarily off the court.

Selecting the correct shoe is key in preventing injury...

Here is a checklist of what to look for when buying shoes:

Choose shoes specific for netball as they have been created to cope with the demands of the sport. Unlike running shoes, netball shoes are designed for side to side movement, are closer to the ground to prevent ankle sprains and their soles have a more durable rubber outsole to provide traction. The outsoles can also vary dependent on whether they are designed for indoor or outdoor netball courts (wider spacing for outdoor and narrower spacing for indoor courts)

Given the movement required in netball, make sure the shoe fits correctly allowing 1cm of space from the longest toe (and that's not always your big toe!). This helps prevent nail damage and minimise the chance of blsiters. It is best to have someone measure your feet properly.

Try on shoes with the same socks you would play in.

Ensure shoes do not become excessively worn - check for heavy wear areas on the outsole, tears or holes in the upper or compression lines on the midsole.

Firm heel counter: prevents excessive rearfoot movement which is especially important in those with achilles tendon issues.

Firm shank: as the main flexion point in a foot is our toes, this is where the shoe should also bend. Test this by pushing up the shoe at the heel and forefoot and seeing where it bends. A shoe that is too flexible compromises its stability and makes the foot prone to injury.

Breathable material: Leather or combination leather upper is suitable to minimise the growth of fungus or bacteria which thrive in moist, warm environments. Regularly air shoes and wear fresh socks, some socks (such as bamboo) can help to wick moisture away too.

Last shape and arch height are also important factors but if the incorrect type is selected this can produce injury.

For some expert advice on selecting suitable shoes, the staff at Athlete's Foot Wollongong or Shellharbour would be more then happy to help. No two feet are the same and not all shoes are made for all feet, therefore having your feet assessed and measured beforehand ensures the staff can help select the correct shoe for you.

A biomechanical assessent by one of our friendly podiatrists can help to pinpoint and address any issues in the lower limb that may predispose you to injury. If you are already experiencing pain then it is definitely time to contact us to book in for an appointment.

Football season is in full swing and you may have started noticing some niggles in your feet which could turn into a problem later in the season. The problem might be your boots, it might be your feet, or it might be both.

Your feet are your most important asset when playing football and if your lower limb/foot health is compromised, performance can suffer. The appropriate fit of your boots is important for comfort, performance and injury prevention.

Here are some tips to help you find the right boot and some information regarding the injuries that can occur.

'Right boot for the right surface'.

Due to the dry summer we have had, most weekend sports are being played on very hard grounds with minimal grass coverage. Make sure you consider stud height and stud distribution when purchasing your boots.

Boots with a lower stud height and greater distribution are best for harder grounds as it increases the surface area of contact. Longer studs have a small surface area of contact, therefore pressure is applied focally to a small area. This can be at the big toe joint, heel or outside of the foot and also increase the chance of ankle sprains. Longer studs are more suited to softer surfaces as they are designed to pierce the turf and give you grip.

Width is another big issue with boots. Make sure when you are buying your boots you try them on with your playing socks. Boots that are too narrow can lead to problems such as ingrown toenails, metatarsal pain, nerve entrapments and more.

Injuries to watch out for this football season...

ACHILLES PAIN - The pain is most commonly around the mid 1/3 of the tendon and can be painful when palpated and when under strain. Symptoms may occur in the morning, before playing or after. The problem may be due to poor biomechanics, weak/tight muscles, inappropriate training loads or poor footwear. Early diagnosis is important to minimise further injury and potential rupture.

HEEL PAIN - Plantar fasciopathy, heel bursitis and heel fat pad syndrome can contribute to pain around and under the heel or can extend in to the arch. This is most often an overuse injury, but in rare cases can be traumatic.

SHIN SPLINTS - Shin splints (medial tibial stress syndrome) and stress fractures can cause pain around the lower leg. These are overuse injuries due to faulty biomechanics or inappropriate training loads for the strength or fitness level of the athlete.

ANKLE SPRAINS - Ankle injuries can be hard to avoid due to the physical nature of the sport. If you do experience a traumatic ankle injury, make sure it is treated appropriately and serious injuries (such as a fracture or soft tissue rupture) are ruled out. Studies have shown that once an ankle injury like this has occurred, the integrity of the joints are weakened permanently so appropriate rehabilitation is important.

STRESS FRACTURE - Early diagnosis and intervention is paramount with this type of fracture. As it is an overuse injury, proper healing is essential for recovery (which can be a lengthy process). The most common areas for stress fractures are the tibia, second metatarsal, sesamoids and styloid process.

TURF TOE - An injury to the plantar plate can occur due to overuse or a traumatic injury from an awkward landing or tackle. It can be a lingering injury which isn't painful enough to stop you from playing, but it can be a serious injury if left untreated and surgery may be required.

NEUROMA - This is an enlargement of a nerve which is irritated by the nerves that surround it. One of the most common causes of this is footwear which is too narrow, particularly football boots so make sure the boot is not too tight across the forefoot and midfoot. Signs that you may have a neuroma include feeling like you are walking on a stone or numbness into the toes.

SKIN AND NAIL PROBLEMS - Blisters, bruised nails and ingrown nails are all very common and can be caused by friction or pressure force. These problems can be easily managed but are best treated by a podiatrist to avoid further issues.

We look forward to keeping you on the field and help manage the above conditions and more...

With it being the beginning of Autumn (and Winter just around the corner) the weather will be soon cooling down.

Many people will soon be ditching their thongs and opened toe shoes/sandals for the warming comfort of an enclosed shoe. To help minimise any issues and keep your feet looking and feeling the best they can, here are a few helpful tips:

Good foot hygiene

As the weather cools, wearing socks or tights with your shoes will be more common. Keeping feet and toes tucked away in darkness will keep them warm and minimise chilblains but this is also the perfect breeding ground for bacteria and fungi leading to problems such as tinea (Athlete's Foot). Therefore, it is important to properly clean and dry your feet daily, particularly between your toes to help prevent these infections. It is also important to wear a new pair of socks or tights daily and even consider changing them more frequently if your feet sweat a lot. Letting your shoes aerate over night will also help combat any problems.

Choosing the correct type of sock

When choosing the type of sock, choose a natural fibre such as cotton or wool to maintain a natural environment and therefore minimise an increase in bacteria and fungi. Some materials that are advertised as having moisture wicking properties may be more beneficial for you if you sweat a lot or work in a damp environment.

Good quality shoes

As with socks, shoe material is another important factor to consider. Well-made, supportive and well-fitted shoes go a long way in ensuring your feet are happy during the cooler months. They can also reduce complications like corns, ingrown toenails and fungal/bacterial infections. Shoes made from natural materials such as leather, are more breathable, durable and adaptable to the shape of your foot. Other materials, such as neoprene (wetsuit material) may not be as breathable, but very beneficial as it adapts well to the shape of your foot and good for those with bunions and hammer toes.

Well its that time of year again - Christmas and New Year has passed and it's time to start thinking about the year ahead!!

For many that means it is time to start organising the kids for Back to School and one of the top items on the list is new school shoes.

Your child can spend up to 40 hours per week in their school shoes which equates to approximately 1500 hours per year so it is important their school shoes are correct and aid their growth and development.

Here are some tips to make sure your child starts the year on the right foot (pun intended!):

It's important that your child is measured correctly for their shoes - making sure both feet are measured as they can be different sizes. The shoe should have a width and depth that matches their foot and their toes end a thumbs width from the end of the shoe.

Make sure the shoes have a firm heel counter so they are not able to be pushed down. They should only flex at the toes and ensure they don't twist easily. A leather upper and non slip sole are also important features to look for as a good quality shoe will always last longer.

The shoes should have a secure fastening mechanism such as laces or velcro - this will ensure the shoes stay on themselves and the foot does not have to overwork to keep the shoe on.

Consider what activities your child will be doing in the shoes. There are plenty of shoes on the market that are appropriate for an active child that loves to run around at lunchtime but still meet school uniform requirements.

A professional shoe fitter will ensure all the above points are considered and the appropriate style is selected. To assist with this it is always a good idea to take your child in the afternoon to have their shoes fitted (feet change size over the course of a day) and take their school socks and orthotics if they wear any.

If you still have any concerns or queries about your children's footwear or notice the following:

*episodes of pain

*regular tripping/falling

*uneven shoe wear

*skin or toenail irritation

come in and visit one of our podiatrists for an assessment and have your questions answered.